|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT BULK TUBE [4081590]
|
Facility
|
OP
|
$1.36
|
|
|
Service Code
|
NDC 0281-0326-30
|
| Hospital Charge Code |
NDG5606
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.80
|
| Rate for Payer: Blue Distinction Transplant |
$0.82
|
| Rate for Payer: Blue Shield of California Commercial |
$0.86
|
| Rate for Payer: Blue Shield of California EPN |
$0.67
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Central Health Plan Commercial |
$1.09
|
| Rate for Payer: Cigna of CA HMO |
$0.95
|
| Rate for Payer: Cigna of CA PPO |
$0.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.16
|
| Rate for Payer: Dignity Health Media |
$1.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.02
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.16
|
| Rate for Payer: Riverside University Health System MISP |
$0.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.68
|
| Rate for Payer: United Healthcare All Other HMO |
$0.68
|
| Rate for Payer: United Healthcare HMO Rider |
$0.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1.16
|
|
|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT BULK TUBE [4081590]
|
Facility
|
IP
|
$1.36
|
|
|
Service Code
|
NDC 0281-0326-30
|
| Hospital Charge Code |
NDG5606
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Blue Shield of California Commercial |
$1.02
|
| Rate for Payer: Blue Shield of California EPN |
$0.73
|
| Rate for Payer: Cash Price |
$0.61
|
| Rate for Payer: Central Health Plan Commercial |
$1.09
|
| Rate for Payer: Cigna of CA HMO |
$0.95
|
| Rate for Payer: Cigna of CA PPO |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.54
|
| Rate for Payer: Galaxy Health WC |
$1.16
|
| Rate for Payer: Global Benefits Group Commercial |
$0.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.27
|
| Rate for Payer: Multiplan Commercial |
$1.02
|
| Rate for Payer: Networks By Design Commercial |
$0.88
|
| Rate for Payer: Prime Health Services Commercial |
$1.16
|
|
|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT PERIPHERAL ISCHEMIA [4085606]
|
Facility
|
OP
|
$2.65
|
|
|
Service Code
|
NDC 0281-0326-08
|
| Hospital Charge Code |
1743605
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.57
|
| Rate for Payer: Blue Distinction Transplant |
$1.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1.67
|
| Rate for Payer: Blue Shield of California EPN |
$1.30
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Central Health Plan Commercial |
$2.12
|
| Rate for Payer: Cigna of CA HMO |
$1.86
|
| Rate for Payer: Cigna of CA PPO |
$1.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.25
|
| Rate for Payer: Dignity Health Media |
$2.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.06
|
| Rate for Payer: Galaxy Health WC |
$2.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.38
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.99
|
| Rate for Payer: Networks By Design Commercial |
$1.72
|
| Rate for Payer: Prime Health Services Commercial |
$2.25
|
| Rate for Payer: Riverside University Health System MISP |
$1.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2.25
|
|
|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT PERIPHERAL ISCHEMIA [4085606]
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
NDC 0281-0326-08
|
| Hospital Charge Code |
1743605
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Blue Shield of California Commercial |
$1.99
|
| Rate for Payer: Blue Shield of California EPN |
$1.42
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Central Health Plan Commercial |
$2.12
|
| Rate for Payer: Cigna of CA HMO |
$1.86
|
| Rate for Payer: Cigna of CA PPO |
$1.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.06
|
| Rate for Payer: Galaxy Health WC |
$2.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.53
|
| Rate for Payer: Multiplan Commercial |
$1.99
|
| Rate for Payer: Networks By Design Commercial |
$1.72
|
| Rate for Payer: Prime Health Services Commercial |
$2.25
|
|
|
NITROGLYCERIN 40 MCG/ML BOLUS FOR ANESTHESIA [4080670]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
ERX4080670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Blue Shield of California Commercial |
$0.14
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.07
|
| Rate for Payer: United Healthcare All Other HMO |
$0.07
|
| Rate for Payer: United Healthcare HMO Rider |
$0.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.06
|
|
|
NITROGLYCERIN 40 MCG/ML BOLUS FOR ANESTHESIA [4080670]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
ERX4080670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.10
|
| Rate for Payer: Blue Distinction Transplant |
$0.11
|
| Rate for Payer: Blue Shield of California Commercial |
$0.11
|
| Rate for Payer: Blue Shield of California EPN |
$0.09
|
| Rate for Payer: Cash Price |
$0.08
|
| Rate for Payer: Central Health Plan Commercial |
$0.14
|
| Rate for Payer: Cigna of CA HMO |
$0.13
|
| Rate for Payer: Cigna of CA PPO |
$0.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.15
|
| Rate for Payer: Dignity Health Media |
$0.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.07
|
| Rate for Payer: Galaxy Health WC |
$0.15
|
| Rate for Payer: Global Benefits Group Commercial |
$0.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.16
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.04
|
| Rate for Payer: Multiplan Commercial |
$0.14
|
| Rate for Payer: Networks By Design Commercial |
$0.09
|
| Rate for Payer: Prime Health Services Commercial |
$0.15
|
| Rate for Payer: Riverside University Health System MISP |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.09
|
| Rate for Payer: United Healthcare All Other HMO |
$0.09
|
| Rate for Payer: United Healthcare HMO Rider |
$0.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.15
|
| Rate for Payer: Vantage Medical Group Senior |
$0.15
|
|
|
NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [5599]
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
CPT J2305
|
| Hospital Charge Code |
1757264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$10.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$1.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.01
|
| Rate for Payer: Blue Distinction Transplant |
$1.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1.08
|
| Rate for Payer: Blue Shield of California EPN |
$0.84
|
| Rate for Payer: Caremore Medicare Advantage |
$1.29
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.37
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.93
|
| Rate for Payer: Dignity Health Media |
$1.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.29
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1.29
|
| Rate for Payer: InnovAge PACE Commercial |
$1.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: Prime Health Services Medicare |
$1.36
|
| Rate for Payer: Riverside University Health System MISP |
$1.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.41
|
| Rate for Payer: Vantage Medical Group Senior |
$1.29
|
|
|
NITROGLYCERIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION [5599]
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
CPT J2305
|
| Hospital Charge Code |
1757264
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Blue Shield of California Commercial |
$1.28
|
| Rate for Payer: Blue Shield of California EPN |
$0.91
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.37
|
| Rate for Payer: Cigna of CA HMO |
$1.20
|
| Rate for Payer: Cigna of CA PPO |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.68
|
| Rate for Payer: Galaxy Health WC |
$1.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.28
|
| Rate for Payer: Networks By Design Commercial |
$0.86
|
| Rate for Payer: Prime Health Services Commercial |
$1.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.65
|
| Rate for Payer: United Healthcare All Other HMO |
$0.63
|
| Rate for Payer: United Healthcare HMO Rider |
$0.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.56
|
|
|
NITROGLYCERIN 5 MG/50 ML D5.2NS SYRINGE [4080695]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
NDC 9994-0806-95
|
| Hospital Charge Code |
NDC4080695
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.52
|
| Rate for Payer: Blue Distinction Transplant |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.43
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.70
|
| Rate for Payer: Cigna of CA HMO |
$0.56
|
| Rate for Payer: Cigna of CA PPO |
$0.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.75
|
| Rate for Payer: Dignity Health Media |
$0.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.79
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
| Rate for Payer: Riverside University Health System MISP |
$0.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Other HMO |
$0.44
|
| Rate for Payer: United Healthcare HMO Rider |
$0.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.75
|
| Rate for Payer: Vantage Medical Group Senior |
$0.75
|
|
|
NITROGLYCERIN 5 MG/50 ML D5.2NS SYRINGE [4080695]
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 9994-0806-95
|
| Hospital Charge Code |
NDC4080695
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Blue Shield of California Commercial |
$0.66
|
| Rate for Payer: Blue Shield of California EPN |
$0.47
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Central Health Plan Commercial |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.35
|
| Rate for Payer: Galaxy Health WC |
$0.75
|
| Rate for Payer: Global Benefits Group Commercial |
$0.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.66
|
| Rate for Payer: Networks By Design Commercial |
$0.57
|
| Rate for Payer: Prime Health Services Commercial |
$0.75
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [208460]
|
Facility
|
OP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$330.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$31.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.81
|
| Rate for Payer: Blue Distinction Transplant |
$220.15
|
| Rate for Payer: Blue Shield of California Commercial |
$36.19
|
| Rate for Payer: Blue Shield of California EPN |
$32.90
|
| Rate for Payer: Caremore Medicare Advantage |
$31.09
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Central Health Plan Commercial |
$293.53
|
| Rate for Payer: Cigna of CA HMO |
$256.84
|
| Rate for Payer: Cigna of CA PPO |
$256.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.63
|
| Rate for Payer: Dignity Health Media |
$31.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.09
|
| Rate for Payer: Galaxy Health WC |
$311.87
|
| Rate for Payer: Global Benefits Group Commercial |
$220.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$330.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$275.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.09
|
| Rate for Payer: InnovAge PACE Commercial |
$46.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.66
|
| Rate for Payer: Multiplan Commercial |
$275.18
|
| Rate for Payer: Networks By Design Commercial |
$183.46
|
| Rate for Payer: Prime Health Services Commercial |
$311.87
|
| Rate for Payer: Prime Health Services Medicare |
$32.95
|
| Rate for Payer: Riverside University Health System MISP |
$34.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.46
|
| Rate for Payer: United Healthcare All Other HMO |
$183.46
|
| Rate for Payer: United Healthcare HMO Rider |
$183.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Vantage Medical Group Senior |
$31.09
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION [208460]
|
Facility
|
IP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.38 |
| Max. Negotiated Rate |
$330.22 |
| Rate for Payer: Blue Shield of California Commercial |
$275.18
|
| Rate for Payer: Blue Shield of California EPN |
$195.93
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Central Health Plan Commercial |
$293.53
|
| Rate for Payer: Cigna of CA HMO |
$256.84
|
| Rate for Payer: Cigna of CA PPO |
$256.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.76
|
| Rate for Payer: Galaxy Health WC |
$311.87
|
| Rate for Payer: Global Benefits Group Commercial |
$220.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$330.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.38
|
| Rate for Payer: Multiplan Commercial |
$275.18
|
| Rate for Payer: Networks By Design Commercial |
$183.46
|
| Rate for Payer: Prime Health Services Commercial |
$311.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.55
|
| Rate for Payer: United Healthcare All Other HMO |
$135.32
|
| Rate for Payer: United Healthcare HMO Rider |
$132.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.08
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [220813]
|
Facility
|
IP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG220813
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.38 |
| Max. Negotiated Rate |
$330.22 |
| Rate for Payer: Blue Shield of California Commercial |
$275.18
|
| Rate for Payer: Blue Shield of California EPN |
$195.93
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Central Health Plan Commercial |
$293.53
|
| Rate for Payer: Cigna of CA HMO |
$256.84
|
| Rate for Payer: Cigna of CA PPO |
$256.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.76
|
| Rate for Payer: Galaxy Health WC |
$311.87
|
| Rate for Payer: Global Benefits Group Commercial |
$220.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$330.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.38
|
| Rate for Payer: Multiplan Commercial |
$275.18
|
| Rate for Payer: Networks By Design Commercial |
$183.46
|
| Rate for Payer: Prime Health Services Commercial |
$311.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.55
|
| Rate for Payer: United Healthcare All Other HMO |
$135.32
|
| Rate for Payer: United Healthcare HMO Rider |
$132.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.08
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION [220813]
|
Facility
|
OP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG220813
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$330.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$31.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.81
|
| Rate for Payer: Blue Distinction Transplant |
$220.15
|
| Rate for Payer: Blue Shield of California Commercial |
$36.19
|
| Rate for Payer: Blue Shield of California EPN |
$32.90
|
| Rate for Payer: Caremore Medicare Advantage |
$31.09
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Central Health Plan Commercial |
$293.53
|
| Rate for Payer: Cigna of CA HMO |
$256.84
|
| Rate for Payer: Cigna of CA PPO |
$256.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.63
|
| Rate for Payer: Dignity Health Media |
$31.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.09
|
| Rate for Payer: Galaxy Health WC |
$311.87
|
| Rate for Payer: Global Benefits Group Commercial |
$220.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$330.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$275.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.09
|
| Rate for Payer: InnovAge PACE Commercial |
$46.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.66
|
| Rate for Payer: Multiplan Commercial |
$275.18
|
| Rate for Payer: Networks By Design Commercial |
$183.46
|
| Rate for Payer: Prime Health Services Commercial |
$311.87
|
| Rate for Payer: Prime Health Services Medicare |
$32.95
|
| Rate for Payer: Riverside University Health System MISP |
$34.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.46
|
| Rate for Payer: United Healthcare All Other HMO |
$183.46
|
| Rate for Payer: United Healthcare HMO Rider |
$183.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Vantage Medical Group Senior |
$31.09
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
|
IP
|
$854.85
|
|
|
Service Code
|
CPT J9298
|
| Hospital Charge Code |
NDG233890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.97 |
| Max. Negotiated Rate |
$769.36 |
| Rate for Payer: Blue Shield of California Commercial |
$641.14
|
| Rate for Payer: Blue Shield of California EPN |
$456.49
|
| Rate for Payer: Cash Price |
$384.68
|
| Rate for Payer: Central Health Plan Commercial |
$683.88
|
| Rate for Payer: Cigna of CA HMO |
$598.40
|
| Rate for Payer: Cigna of CA PPO |
$598.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$341.94
|
| Rate for Payer: Galaxy Health WC |
$726.62
|
| Rate for Payer: Global Benefits Group Commercial |
$512.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$769.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.97
|
| Rate for Payer: Multiplan Commercial |
$641.14
|
| Rate for Payer: Networks By Design Commercial |
$427.42
|
| Rate for Payer: Prime Health Services Commercial |
$726.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.79
|
| Rate for Payer: United Healthcare All Other HMO |
$315.27
|
| Rate for Payer: United Healthcare HMO Rider |
$308.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.10
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION [233890]
|
Facility
|
OP
|
$854.85
|
|
|
Service Code
|
CPT J9298
|
| Hospital Charge Code |
NDG233890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$170.97 |
| Max. Negotiated Rate |
$1,159.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$187.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,159.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$233.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$338.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$370.92
|
| Rate for Payer: Blue Distinction Transplant |
$512.91
|
| Rate for Payer: Blue Shield of California Commercial |
$537.70
|
| Rate for Payer: Blue Shield of California EPN |
$418.02
|
| Rate for Payer: Caremore Medicare Advantage |
$187.15
|
| Rate for Payer: Cash Price |
$384.68
|
| Rate for Payer: Cash Price |
$384.68
|
| Rate for Payer: Central Health Plan Commercial |
$683.88
|
| Rate for Payer: Cigna of CA HMO |
$598.40
|
| Rate for Payer: Cigna of CA PPO |
$598.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$233.94
|
| Rate for Payer: Dignity Health Media |
$205.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$187.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$187.15
|
| Rate for Payer: Galaxy Health WC |
$726.62
|
| Rate for Payer: Global Benefits Group Commercial |
$512.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$769.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$641.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$306.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$308.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$187.15
|
| Rate for Payer: InnovAge PACE Commercial |
$280.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$250.79
|
| Rate for Payer: Multiplan Commercial |
$641.14
|
| Rate for Payer: Networks By Design Commercial |
$427.42
|
| Rate for Payer: Prime Health Services Commercial |
$726.62
|
| Rate for Payer: Prime Health Services Medicare |
$198.38
|
| Rate for Payer: Riverside University Health System MISP |
$205.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$512.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$512.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.42
|
| Rate for Payer: United Healthcare All Other HMO |
$427.42
|
| Rate for Payer: United Healthcare HMO Rider |
$427.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$233.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.87
|
| Rate for Payer: Vantage Medical Group Senior |
$205.87
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
IP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.38 |
| Max. Negotiated Rate |
$330.22 |
| Rate for Payer: Blue Shield of California Commercial |
$275.18
|
| Rate for Payer: Blue Shield of California EPN |
$195.93
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Central Health Plan Commercial |
$293.53
|
| Rate for Payer: Cigna of CA HMO |
$256.84
|
| Rate for Payer: Cigna of CA PPO |
$256.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.76
|
| Rate for Payer: Galaxy Health WC |
$311.87
|
| Rate for Payer: Global Benefits Group Commercial |
$220.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$330.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.38
|
| Rate for Payer: Multiplan Commercial |
$275.18
|
| Rate for Payer: Networks By Design Commercial |
$183.46
|
| Rate for Payer: Prime Health Services Commercial |
$311.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$138.55
|
| Rate for Payer: United Healthcare All Other HMO |
$135.32
|
| Rate for Payer: United Healthcare HMO Rider |
$132.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.08
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION [208459]
|
Facility
|
OP
|
$366.91
|
|
|
Service Code
|
CPT J9299
|
| Hospital Charge Code |
NDG208459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$330.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$31.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.81
|
| Rate for Payer: Blue Distinction Transplant |
$220.15
|
| Rate for Payer: Blue Shield of California Commercial |
$36.19
|
| Rate for Payer: Blue Shield of California EPN |
$32.90
|
| Rate for Payer: Caremore Medicare Advantage |
$31.09
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Central Health Plan Commercial |
$293.53
|
| Rate for Payer: Cigna of CA HMO |
$256.84
|
| Rate for Payer: Cigna of CA PPO |
$256.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.63
|
| Rate for Payer: Dignity Health Media |
$31.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$31.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.09
|
| Rate for Payer: Galaxy Health WC |
$311.87
|
| Rate for Payer: Global Benefits Group Commercial |
$220.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$330.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$275.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.09
|
| Rate for Payer: InnovAge PACE Commercial |
$46.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.66
|
| Rate for Payer: Multiplan Commercial |
$275.18
|
| Rate for Payer: Networks By Design Commercial |
$183.46
|
| Rate for Payer: Prime Health Services Commercial |
$311.87
|
| Rate for Payer: Prime Health Services Medicare |
$32.95
|
| Rate for Payer: Riverside University Health System MISP |
$34.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.46
|
| Rate for Payer: United Healthcare All Other HMO |
$183.46
|
| Rate for Payer: United Healthcare HMO Rider |
$183.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.20
|
| Rate for Payer: Vantage Medical Group Senior |
$31.09
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
IP
|
$429.49
|
|
|
Service Code
|
CPT 90621
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.90 |
| Max. Negotiated Rate |
$386.54 |
| Rate for Payer: Blue Shield of California Commercial |
$322.12
|
| Rate for Payer: Blue Shield of California EPN |
$229.35
|
| Rate for Payer: Cash Price |
$193.27
|
| Rate for Payer: Central Health Plan Commercial |
$343.59
|
| Rate for Payer: Cigna of CA HMO |
$300.64
|
| Rate for Payer: Cigna of CA PPO |
$300.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$171.80
|
| Rate for Payer: Galaxy Health WC |
$365.07
|
| Rate for Payer: Global Benefits Group Commercial |
$257.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$386.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.90
|
| Rate for Payer: Multiplan Commercial |
$322.12
|
| Rate for Payer: Networks By Design Commercial |
$214.74
|
| Rate for Payer: Prime Health Services Commercial |
$365.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.18
|
| Rate for Payer: United Healthcare All Other HMO |
$158.40
|
| Rate for Payer: United Healthcare HMO Rider |
$154.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.73
|
|
|
N.MENINGITIDIS GROUP B,LIPID FHBP 120 MCG/0.5 ML INTRAMUSCULAR SYRINGE [207979]
|
Facility
|
OP
|
$429.49
|
|
|
Service Code
|
CPT 90621
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.90 |
| Max. Negotiated Rate |
$1,788.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,123.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$365.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,633.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,788.99
|
| Rate for Payer: Blue Distinction Transplant |
$257.69
|
| Rate for Payer: Blue Shield of California Commercial |
$197.69
|
| Rate for Payer: Blue Shield of California EPN |
$179.72
|
| Rate for Payer: Cash Price |
$193.27
|
| Rate for Payer: Cash Price |
$193.27
|
| Rate for Payer: Central Health Plan Commercial |
$343.59
|
| Rate for Payer: Cigna of CA HMO |
$300.64
|
| Rate for Payer: Cigna of CA PPO |
$300.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.07
|
| Rate for Payer: Dignity Health Media |
$365.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$171.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$171.80
|
| Rate for Payer: Galaxy Health WC |
$365.07
|
| Rate for Payer: Global Benefits Group Commercial |
$257.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$386.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$322.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.90
|
| Rate for Payer: Multiplan Commercial |
$322.12
|
| Rate for Payer: Networks By Design Commercial |
$214.74
|
| Rate for Payer: Prime Health Services Commercial |
$365.07
|
| Rate for Payer: Riverside University Health System MISP |
$171.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$257.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$257.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$214.74
|
| Rate for Payer: United Healthcare All Other HMO |
$214.74
|
| Rate for Payer: United Healthcare HMO Rider |
$214.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.07
|
| Rate for Payer: Vantage Medical Group Senior |
$365.07
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$17,629.97
|
|
|
Service Code
|
APR-DRG 0502
|
| Min. Negotiated Rate |
$11,134.72 |
| Max. Negotiated Rate |
$17,629.97 |
| Rate for Payer: Adventist Health Medi-Cal |
$11,134.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,268.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,629.97
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$27,963.92
|
|
|
Service Code
|
APR-DRG 0503
|
| Min. Negotiated Rate |
$17,661.42 |
| Max. Negotiated Rate |
$27,963.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,661.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21,046.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27,963.92
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$10,145.96
|
|
|
Service Code
|
APR-DRG 0501
|
| Min. Negotiated Rate |
$6,407.98 |
| Max. Negotiated Rate |
$10,145.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,407.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,636.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,145.96
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$57,279.20
|
|
|
Service Code
|
APR-DRG 0504
|
| Min. Negotiated Rate |
$36,176.34 |
| Max. Negotiated Rate |
$57,279.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$36,176.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43,110.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57,279.20
|
|
|
NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$55,009.18
|
|
|
Service Code
|
APR-DRG 3234
|
| Min. Negotiated Rate |
$34,742.64 |
| Max. Negotiated Rate |
$55,009.18 |
| Rate for Payer: Adventist Health Medi-Cal |
$34,742.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41,401.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55,009.18
|
|
